In the 19 August 2005 issue Science published 4 letters and a response
by the authors regarding the 22 April policy forum.
This page contains quotes from the letters and our complete response. For
access to the complete letters please see theScience magazine web site.

Science, Vol 309, Issue 5738, 1182-1185 , 19 August 2005

Quotes that Science highlighted:

Page 1182:"But what if child sexual abuse were a newly discovered
disease--a disease that affects up to 20% of women and 10% of men... a disease
that... costs society over $24 billion each year?" - Fink

Quotes from the 4 Letters

1. Fink: "The Policy Forum "The science of child
sexual abuse" by J. J. Freyd et al. (22 Apr., p. 501) provides an extremely
important call to action to the scientific community". .....We have severely
underestimated the effects of this problem on our children's health. It is time
to recognize that the problem is not solely a product of the action of a few
sick individuals; child sexual abuse is a preventable health problem that has
been allowed to spread unabated due to scientific and social neglect."

2. Read: "In the Policy Forum "The science of child sexual
abuse" (22 Apr., p. 501), J. J. Freyd and colleagues succinctly summarized
an enormous amount of research and rightly highlighted the depressing bias of
those researchers who "emphasized false allegations rather than false denials."
It is a sad fact of life that after decades of ignoring the issue altogether,
research showing the alarming prevalence of child abuse has met with a kind
of 'backlash.'"

John Read. Psychology Department, University of Auckland, Auckland 1020, New
Zealand

3. Dawes: "In their Policy Forum "The science of child sexual
abuse" (22 Apr., p. 501), J. J. Freyd et al. assert that '[s]urveys likely
underestimate prevalence [of child sexual abuse] because of underreporting and
memory failure' There is no way of making that inference."

4. Kihlstrom, McNally, Loftus, and H. Pope: "The notion that individuals
can develop amnesia for seemingly unforgettable traumatic events, followed by
'recovery' of these memories months or years later, has been part of the folklore
of psychiatry and clinical psychology for more than 100 years ....Genuinely
traumatic events--those experienced at the time as overwhelmingly terrifying
and life-threatening--are seldom, if ever, truly forgotten."

Response

We concur with the Letter writers that child sexual abuse (CSA) is a serious public
health problem. We also agree with Read that links between CSA and adult psychosis
(1) should not be overlooked.

As Dawes indicates, one must take into account both false allegations and denials
in determining the prevalence of sexual abuse. However, evidence indicates that
false allegations occur at rates lower than nondisclosure rates. Prevalence
is underestimated (in Dawes' notation, c < b) whenever the likelihood that
reports of abuse are false [c/(a c)] is less than the likelihood that true abuse
is not disclosed [b/(a b)]. Mechanisms of false allegations, such as suggestive
therapy or interviewer bias, occur in a small minority of abuse reports: 2%
of survey respondents claiming abuse report having recovered their memory with
the help of a professional or others (2), and approximately 10% report that
the abuse was disclosed to authorities, setting an upper bound on adult influences
(3). On the other hand, most surveys of adults with "well-documented serious
abuse or neglect" have found nondisclosure rates over 30% [(4), p. 270].

High rates of nondisclosure also speak to Kihlstrom and colleagues' assertion
that sexual abuse is "seldom, if ever, truly forgotten." Although
underreporting is attributable in part to abuse victims' reluctance to disclose,
Williams' (5) difficulty in eliciting abuse reports despite extensive questioning
of women with documented abuse histories led Loftus et al. (6) to acknowledge
that "many children can forget about a sexually abusive experience from
their past" (p. 1177). What Kihlstrom et al. call "folklore"
is actually over 100 years of clinical and scientific evidence for the forgetting
of trauma (7). Although the frequency and mechanisms of forgetting are not completely
clear, the basic phenomenon is documented in dozens of empirical studies (8)
and corroborated case studies (9).

Kihlstrom et al. argue that trauma victims typically remember their experiences
"all too well." However, both intrusive recall and an "inability
to recall an important aspect of the trauma" [(10), p. 428] are diagnostic
of pathological posttraumatic conditions and may both reflect, in part, some
common underlying disregulation of memory processes (8). Indeed, traumatized
individuals exhibit a range of memory impairments (11). Research on executive
control over recall of unwanted memories (12), and research on children's (13)
and adults' (14) encoding and memory of trauma stimuli has provided preliminary
support for models of repression and traumatic amnesia. The relations among
the effects of trauma on encoding, retrieval inhibition, and memory functioning
are worthy of future study.

In our Policy Forum, we recommended a series of international consensus panels
on scientific and clinical practice issues related to CSA, expansion of the
National Child Traumatic Stress Network, and the creation of a new Institute
of Child Abuse and Interpersonal Violence within the NIH that would foster research
on CSA and related conditions. Claims that traumatic amnesia rarely occurs,
as well as legitimate disagreements over the prevalence and accurate recall
of CSA, reinforce these recommendations. Denial and underestimation of the effects
of CSA continue to be serious obstacles to ending a preventable public health
problem.

Jennifer J. Freyd, Department of Psychology, University of Oregon, Eugene,
OR 97403-1227, USA